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Clinical Updates on Shoulder Arthroplasty

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (20 October 2025) | Viewed by 13193

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Special Issue Editors

Dr. Pietro Gregori

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1. Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
2. Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
Interests: reverse shoulder arthroplasty (RSA); total shoulder arthroplasty (TSA); hemiarthroplasty; rotator cuff arthropathy; osteoarthritis

Dr. Edoardo Franceschetti

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Prof. Dr. Rocco Papalia

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1. Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21-00128, Rome, Italy
2. Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128, Rome, Italy
Interests: reverse shoulder arthroplasty (RSA); total shoulder arthroplasty (TSA); hemiarthroplasty; osteoarthritis; knee surgery; hip surgery
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Prof. Dr. Umile Giuseppe Longo

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1. Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
2. Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
Interests: reverse shoulder arthroplasty (RSA); total shoulder arthroplasty (TSA); rotator cuff arthropathy; osteoarthritis; proximal humeral fractures
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Medical practices are increasingly influenced by technological advancements and more personalized approaches to the care of each patient. In shoulder arthroplasty surgery, the constant evolution of the implant design and combinations aims to achieve improved clinical outcomes in the shortest possible time. Also, precise indications and specific surgical techniques are used to select the right treatment for the patient, while more studies are needed to define patient satisfaction, cost-effectiveness, safety, and optimal ways of increasing functional recovery and minimizing complications. For reverse shoulder arthroplasty, the most-discussed themes are the benefits of artificial intelligence, the role of preoperative 3D planning software, lateralization, and optimal humeral size and inclination. For anatomic arthroplasty, more precise indications and implant configurations are needed to reduce revsion rates. This Special Issue will improve knowledge of clinical, technical, and epidemiological advances that could lead to improvements in the diagnosis and treatment of shoulder arthroplasty.

Dr. Pietro Gregori
Dr. Edoardo Franceschetti
Prof. Dr. Rocco Papalia
Prof. Dr. Umile Giuseppe Longo
Guest Editors

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Keywords

reverse shoulder arthroplasty (RSA)
rotator cuff arthropathy
revisions
hemiarthroplasty
proximal humeral fractures
osteoarthritis
3D planning
complications
total shoulder arthroplasty (TSA)

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Published Papers (8 papers)

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Research

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10 pages, 941 KB

Open AccessArticle

Preoperative Radiographic Thoracic Kyphosis Relates to Scapular Internal Rotation but Not Anterior Tilt in Candidates for Reverse Shoulder Arthroplasty: A Retrospective Radiographic Analysis from the FP-UCBM Shoulder Study Group

by Edoardo Franceschetti, Pietro Gregori, Chiara Capperucci, Mauro La Bruna, Giancarlo Giurazza, Andrea Tanzilli, Michele Paciotti, Cirino Amato, Umile Giuseppe Longo and Rocco Papalia

J. Clin. Med. 2025, 14(22), 8183; https://doi.org/10.3390/jcm14228183 - 18 Nov 2025

Viewed by 425

Abstract

Background/Objectives: In the elderly population, thoracic kyphosis often progresses with age, leading to secondary postural adaptations including scapular protraction, internal rotation, and anterior tilt. These alterations can potentially compromise shoulder biomechanics, particularly in patients undergoing reverse shoulder arthroplasty (RSA). The purpose of this study was to evaluate the relationship between thoracic sagittal alignment, quantified by the Cobb angle, and scapular internal rotation (SIR) assessed on CT scans in patients scheduled for RSA. Methods: A retrospective study was conducted on 164 patients who underwent RSA between 2016 and 2024 at a single tertiary referral center. Sagittal thoracic kyphosis was assessed using the Cobb angle measured on preoperative chest radiographs. SIR and anterior scapular tilt were evaluated using preoperative CT scans. Patients were divided into three groups according to the Cobb angle: Group A (≤36°), Group B (>36–46°), and Group C (≥47°). Statistical analysis was performed using the Spearman correlation coefficient and Kruskal–Wallis test, with a significance threshold set at p < 0.05. Results: Analysis demonstrated a weak but statistically significant positive correlation between age and SIR, as well as between thoracic kyphosis (Cobb angle) and SIR. Patients in Group C (Cobb angle ≥ 47°) showed higher mean SIR values (43.7°) compared to Group A (40.3°), with statistical significance achieved (p = 0.047). These findings suggest that greater thoracic kyphosis is associated with increased scapular internal rotation. No significant correlation was identified between anterior scapular tilt and thoracic kyphosis. Conclusions: This study reveals a correlation between increased thoracic kyphosis and greater scapular internal rotation in patients undergoing RSA. These postural and biomechanical alterations may have critical implications for surgical planning and postoperative outcomes. Preoperative assessment of sagittal spinal alignment, particularly thoracic kyphosis, should be integrated into the planning process for RSA to optimize implant positioning and improve functional results. Full article

(This article belongs to the Special Issue Clinical Updates on Shoulder Arthroplasty)

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17 pages, 2801 KB

Open AccessArticle

Glenoid Radiolucent Lines and Subsidence Show Limited Impact on Clinical and Functional Long-Term Outcomes After Anatomic Total Shoulder Arthroplasty: A Retrospective Analysis of Cemented Polyethylene Glenoid Components

by Felix Hochberger, Jonas Limmer, Justus Muhmann, Frank Gohlke, Laura Elisa Streck, Maximilian Rudert and Kilian List

J. Clin. Med. 2025, 14(19), 7058; https://doi.org/10.3390/jcm14197058 - 6 Oct 2025

Viewed by 755

Abstract

Background: Glenoid radiolucenct lines (gRLL) and glenoid component subsidence (gSC) after anatomic total shoulder arthroplasty (aTSA) have traditionally been linked to implant loosening and functional decline. However, their impact on long-term clinical outcomes remains unclear. This study aimed to evaluate whether gRLL and gSC are associated with inferior clinical or functional results in patients without revision surgery. Methods: In this retrospective study, 52 aTSA cases (2008–2015) were analyzed with a minimum of five years of clinical and radiographic follow-up. Based on final imaging, patients were categorized according to the presence and extent of gRLL and gSC. Clinical outcomes included the Constant-Murley Score, DASH, VAS for pain, and range of motion (ROM). Radiographic parameters included the critical shoulder angle (CSA), acromiohumeral distance (AHD), lateral offset (LO), humeral head-stem index (HSI), and cranial humeral head decentration (DC). Group comparisons were conducted between: (1) ≤2 vs. 3 gRLL zones, (2) 0 vs. 1 zone, (3) 0 vs. 3 zones, (4) gSC vs. no gSC, and (5) DC vs. no DC. Results: Demographics and baseline characteristics were comparable across groups. Functional scores (Constant, DASH), pain (VAS), and ROM were largely similar. Patients with extensive gRLL showed reduced external rotation (p = 0.01), but the difference remained below the MCID. Similarly, gSC was associated with lower forward elevation (p = 0.04) and external rotation (p = 0.03), both below MCID thresholds. No significant differences were observed for DC. Conclusions: Neither extensive gRLL nor gSC significantly impaired long-term clinical or functional outcomes. As these radiographic changes can occur in the absence of symptoms, regular radiographic monitoring is essential, and revision decisions should be made individually in cases of progressive bone loss. Full article

(This article belongs to the Special Issue Clinical Updates on Shoulder Arthroplasty)

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11 pages, 2306 KB

Open AccessArticle

Lateralization and Distalization Shoulder Angles in Reverse Shoulder Arthroplasty: Are They Still Reliable and Accurate in All Patients and for All Prosthetic Designs?

by Koray Şahin, Hakan Batuhan Kaya, Christos Koukos, Mehmet Kapıcıoğlu and Kerem Bilsel

J. Clin. Med. 2025, 14(4), 1393; https://doi.org/10.3390/jcm14041393 - 19 Feb 2025

Cited by 2 | Viewed by 1743

Abstract

Background: Recently, the lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) have been proposed to assess lateralization and distalization in reverse shoulder arthroplasty (RSA). However, there is insufficient evidence about the influence of patient anatomy and prosthesis design on these measurements. This study aims to investigate the impact of patient anatomy and implant design on LSA and DSA measurements and to assess the validity of the previously reported “optimal” ranges for these parameters. Methods: Patients who underwent the RSA procedure using four different prosthetic designs between April 2014 and June 2023 were retrospectively evaluated. Postoperative LSA and DSA measurements were compared according to implant design, preoperative glenoid morphology (Favard classification), and the Hamada grade. The correlation of LSA and DSA with preoperative shoulder anatomy (critical shoulder angle, CSA, and acromial index, AI) was also assessed. Results: In total, 135 shoulders were included in the study, with a mean age of 71.7 ± 7.9 years. The mean LSA was 88.4 ± 11.8° and mean DSA was 40.6 ± 12.5°. According to prosthetic design, both mean LSA and DSA values differed significantly (p < 0.05). Lateralized designs (Groups I and IV) had significantly higher mean LSA values. The Favard classification and Hamada grade of shoulders did not show a significant influence on LSA and DSA measurements (p > 0.05). DSA was observed to be significantly correlated with CSA and AI (p < 0.05; r = −0.27 and −0.189, respectively). Conclusions: Prosthetic design and preoperative shoulder anatomy had a significant influence on LSA and DSA measurements in RSA. Optimal LSA and DSA values may lack validity and reliability and should not be applied to all patients. Full article

(This article belongs to the Special Issue Clinical Updates on Shoulder Arthroplasty)

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10 pages, 416 KB

Open AccessArticle

Testosterone Replacement Therapy Is Not Associated with Greater Revision Rates in Reverse Total Shoulder Arthroplasty

by Romir P. Parmar, Austin Cronen, Clayton Hui, Michael Stickels, Evan Lederman and Anup Shah

J. Clin. Med. 2025, 14(4), 1341; https://doi.org/10.3390/jcm14041341 - 18 Feb 2025

Cited by 1 | Viewed by 2257

Abstract

Background/Objectives: Testosterone replacement therapy (TRT) has become increasingly common, particularly for patients with symptomatic hypogonadism or individuals undergoing gender-affirming therapy. The current literature is inconclusive on the association between TRT and orthopedic surgery. This study sought to examine outcomes of reverse total shoulder arthroplasty (RSA) in patients receiving TRT. Methods: A retrospective cohort of RSA patients from 2010 to 2022 was queried using the PearlDiver database. Patients were included if they underwent RSA with at least 2 years of follow-up. Patients who underwent at least 90 days of TRT prior to their surgery were matched by Charlson Comorbidity Index, age, and gender to a control cohort. Univariate analysis using chi-squared tests and Student’s t-tests were used to compare demographics outcomes between groups. Results: A total of 1906 patients were identified who used TRT within 90 days of undergoing RSA, and these patients were matched to a control cohort of 1906 patients. Patients who used TRT within 90 days did not have significantly different rates of revision RSA (12.01%) compared to those without use (11.02%) (p = 0.335). Furthermore, between the TRT group and the control group, PJI rates (1.42% vs. 1.63%; p = 0.597) and periprosthetic fracture rates (0.58% vs. 1.05%, p = 0.105) were not significantly different. Conclusions: This study demonstrated that TRT use within 90 days of RSA does not increase the rates of revision, fracture, or infection. These results can assist surgeons when evaluating patients on TRT who also may be candidates for RSA. Full article

(This article belongs to the Special Issue Clinical Updates on Shoulder Arthroplasty)

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11 pages, 1390 KB

Open AccessArticle

Comparison of Short Uncemented Metaphyseal Stem and Long-Stem Reverse Shoulder Arthroplasty in Proximal Humerus Fractures: Preliminary Study at 2-Year Follow-Up

by Giorgio Ippolito, Riccardo Maria Lanzetti, Sergio Ferraro, Valerio Pace, Marco Damo, Michele Francesco Surace, Alessio Davide Enrico Giai Via, Michele Crivellaro, Giancarlo De Marinis and Marco Spoliti

J. Clin. Med. 2024, 13(16), 4665; https://doi.org/10.3390/jcm13164665 - 8 Aug 2024

Viewed by 1910

Abstract

Introduction: In the last few years, short metaphyseal-socket prosthetic humeral stems have been introduced for reverse shoulder arthroplasty (RSA). A short stem may have advantages in humeral force distribution, reducing shear stress and preserving bone stock, keeping in mind the need for possible future revision surgery. The main objective of our study was to validate the use of a short stem prosthesis in the surgical treatment of humeral fractures by comparing clinical and radiological outcomes of our studied implant with those obtained with the use of traditional long-stem implants. Methods: In this multicentric, controlled prospective study, 125 patients with proximal three- or four-fragment humerus fractures were selected and treated with RSA. A short stem was used in group A (n = 53, mean age: 75.6 ± 5.6 years old), and a long stem was used in group B (n = 72, mean age: 71.76 ± 3). Active range of motion (ROM), Constant score (CS), Quick DASH, American Shoulder and Elbow Surgeons Shoulder (ASES) score, and Visual Analog Scale (VAS) scores were collected and analyzed at 2 years mean follow-up, as well as humeral and glenoid bone resorption (sum Inoue scores and Sirveaux scores were used). Results: No statistically significant differences were observed between group A and B in ROM, Constant score (51.69 ± 15.8 vs. 53.46 ± 15.96, p > 0.05), Quick DASH (31.5 ± 21.81 vs. 28.79 ± 13.72, p = 0.85), ASES (82.53 ± 17.79 vs. 84.34 ± 15.24, p = 0.57), or the VAS (0.53 ± 1 vs. 0.56 ± 1.07, p = 0.14) at the final follow-up. No statistically significant differences were found in the radiographic parameters between the two groups. No statistically significant differences were found for the average degree of humeral and glenoid bone resorption either. Conclusions: The use of a short metaphyseal-socket stem can be considered a safe, effective, and feasible option in reverse shoulder arthroplasty for treating proximal humerus fractures. Our results are encouraging, with no statistically significant differences identified between the proposed treatment and traditional long stems. Full article

(This article belongs to the Special Issue Clinical Updates on Shoulder Arthroplasty)

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11 pages, 2590 KB

Open AccessArticle

Bone Density Changes at the Origin of the Deltoid Muscle following Reverse Shoulder Arthroplasty

by Antonio Caldaria, Edoardo Giovannetti de Sanctis, Luca Saccone, Angelo Baldari, Danila Azzolina, Luca La Verde, Alessio Palumbo and Francesco Franceschi

J. Clin. Med. 2024, 13(13), 3695; https://doi.org/10.3390/jcm13133695 - 25 Jun 2024

Viewed by 2212

Abstract

Background: Reverse total shoulder arthroplasty (RSA) significantly impacts deltoid length, tension, and structure. Studies have extensively investigated various modifications in deltoid characteristics, such as perfusion, elasticity, caliber, histological changes, and strength post-RSA. However, to date, there is a notable absence of research evaluating changes in bone mineral density (BMD) at the deltoid muscle origin after the RSA procedure. Methods: A retrospective analysis of a consecutive series of RSAs performed between May 2011 and May 2022 was conducted. Inclusion criteria comprised primary RSAs with both preoperative and last follow-up shoulder CT scans and a minimum follow-up of 12 months. Trabecular attenuation measured in Hounsfield units (HU) was calculated using a rapid region-of-interest (ROI) method. BMD analysis involved segmenting three ROIs in both pre- and postoperative CT scans of each patient: the acromion, clavicle, and spine of the scapula. Results: A total of 44 RSAs in 43 patients, comprising 29 women and 14 men, were included in this study. The mean follow-up duration was 49 ± 22.64 months. Significant differences were observed between preoperative and postoperative HU values in all analyzed regions. Specifically, BMD increased in the acromion and spine, while it decreased in the clavicle (p-values 0.0019, <0.0001, and 0.0088, respectively). Conclusions: The modifications in shoulder biomechanics and, consequently, deltoid tension post-implantation result in discernible variations in bone quality within the analyzed regions. This study underscores the importance of thorough preoperative patient planning. By utilizing CT images routinely obtained before reverse shoulder replacement surgery, patients at high risk for fractures of the acromion, clavicle, and scapular spine can be identified. Full article

(This article belongs to the Special Issue Clinical Updates on Shoulder Arthroplasty)

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Review

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11 pages, 1462 KB

Open AccessReview

Computer-Assisted Navigation in Shoulder Arthroplasty: A Narrative Review

by Marina Marescalchi, Alessandro El Motassime, Luca Andriollo, Alberto Polizzi, Giuseppe Niccoli and Vincenzo Morea

J. Clin. Med. 2025, 14(8), 2763; https://doi.org/10.3390/jcm14082763 - 17 Apr 2025

Cited by 3 | Viewed by 1741

Abstract

Shoulder arthroplasty, including total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA), is a well-established procedure for treating degenerative, post-traumatic, and inflammatory conditions of the shoulder joint. The success of these surgeries depends largely on the precise placement of implants, which helps restore proper joint mechanics, reduce complications, and extend the lifespan of the prosthesis. However, achieving accurate implant positioning can be challenging, especially in cases involving severe bone loss, anatomical deformities, or prior surgeries. Poor alignment can lead to instability, implant loosening, and the need for revision surgery. Computer-assisted navigation has become an important tool in shoulder arthroplasty, providing real-time intraoperative guidance to improve surgical accuracy and consistency. By integrating preoperative 3D imaging with intraoperative tracking, navigation technology allows surgeons to optimize glenoid component placement, reducing the risk of malalignment and mechanical failure. Research suggests that navigation-assisted techniques improve precision, enhance functional outcomes, and may even reduce complication rates by optimizing fixation strategies, such as using fewer but longer screws in RSA. Despite its benefits, navigation in shoulder arthroplasty is not without challenges. It requires additional surgical time, increases costs, and demands a learning curve for surgeons. However, with advancements in artificial intelligence, augmented reality, and robotic-assisted surgery, navigation is expected to become even more effective and accessible. This review explores the current impact of navigation on clinical outcomes, its role in complex cases, and the future potential of this technology. While early results are promising, further long-term studies are needed to fully assess its value and establish best practices for its routine use in shoulder arthroplasty. Full article

(This article belongs to the Special Issue Clinical Updates on Shoulder Arthroplasty)

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Other

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8 pages, 2016 KB

Open AccessCase Report

Reverse Total Shoulder Arthroplasty for Proximal Humerus Nonunion

by James Tyler Frix, Maria Kammire, Nainisha Chintalapudi and Patrick Connor

J. Clin. Med. 2025, 14(14), 5130; https://doi.org/10.3390/jcm14145130 - 18 Jul 2025

Viewed by 1091

Abstract

Background: Surgical neck nonunions of the proximal humerus present a complex clinical challenge, especially in elderly patients with pre-existing glenohumeral arthritis. Reverse total shoulder arthroplasty (RTSA) offers a reliable treatment option in these cases; however, resection of the tuberosities may compromise joint stability, increase the risk of postoperative dislocation and compromise postoperative function. This article describes a reproducible RTSA technique that preserves and repairs the greater and lesser tuberosities, aiming to enhance construct stability and optimize outcomes. Methods: We present a 74-year-old female with underlying glenohumeral arthritis who underwent RTSA for a symptomatic surgical neck nonunion via an extended deltopectoral approach. The nonunion is first mobilized, and tuberosity osteotomies are performed. After implant placement, the tuberosities are secured to the implant, to each other, and to the humeral shaft. A cerclage suture is also passed circumferentially to reinforce the repair and prevent posterior gapping. Results: The patient regained her pre-injury level of function by her last follow-up. She had pain-free, active forward elevation to 110 degrees and radiographic evidence of maintained tuberosity reduction and healing. There was no evidence of instability. Conclusions: In conclusion, incorporating tuberosity preservation and repair into RTSA for proximal humerus nonunion may reduce dislocation risk and improve functional recovery in elderly, low-demand patients. Full article

(This article belongs to the Special Issue Clinical Updates on Shoulder Arthroplasty)

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